Healthcare in America

[rs2006]

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Hi everyone,

I hope all is well for everyone in the forum. Recently, a classmate of mine had some abdominal surgery for which she received the bill for the surgery and her hospital stay last week which amounted to approx $31k after insurance. Now given this fact, and the fact that this is a medical student (who does not have a real income) with health insurance and that this person could just as well be someone in the workforce earning real money, how are people supposed to pay for healthcare?--- She also told me that her anesthesiologist billed a couple of thousand dollars for their services and that the surgeon received a few hundred dollars for the procedure. Now given this, and the fact that this person may just as well been someone who earns the median household income in the US (approk a little more than $43k according to the US census data), how do physicians and hospitals really get compensated for their services-- do physicians just end up having to bill alot of money just to be compensated a small percentage of what they bill for and if not, how are physicians and other medical professionals STILL able to make the kind of money that they do (approx 400k/yr for anesthesia, and 250k/yr for surgery, etc)? Also, what is the reality of compensation in the real world-- do you really get compensated for all the money that you bill for, and if not what do you do if you are not getting compensated by insurance companies, patients (given the reality that lets say a person makes 43k/yr and they have 100k in medical bills-- are they really going to be able to pay them-- what happens to the hospital/physician in that case?)? Any thoughts would be much appreciated to a confused fourth year medical student Thanks-- sorry for the rambling message!!

 

[powermd]

The physician fees are a blip on the radar compared to the fees for staying in the hospital and using the OR. OR time costs about $60/min, and it sounds like your friend had a looooong procedure if the anesthesia bill was a few thousand. Staying one night on a regular floor at Columbia costs $3200, according to one of the surgeons I work with. I was talking about opening up an offshore surgi-center, and he was very supportive, saying people would definitely make the trip because it would be so much cheaper than the US.

 

[fedor]

What procedure was it? Maybe that can shed some light on the $2000 fee.

 

[rn29306]

Here's an example of why insurance is so messed up. Senior year in college, I had a procedure done under GA by a plastic surgeon. He had his own OR suite across from the town's major hospital. My insurance company had a policy of not allowing more than $500 for ANY in-office procedure. His estimate for the in-house procedure, including a CRNA from the hospital for anesthesia, was $1,300 - $1,500. Insurance said no, go to the hospital. What was the hospital tab? $11,000 and some pocket change for a one hour operation. And a CRNA still did the procedure.
Didn't meet the CRNA until I was in the room and already strapped down, he came in and put a mask on my face. I jerked away and asked him at least to tell me his name. NEVER even met the anesthesiologist. Not in pre-op, not post-op. My parents came down for the op and they never met him either. And don't think I didn't get a nice bill from him. What a crappy system at this hospital.
This example is not a MD or CRNA thing at all, just trying to explain the details. In fact, this experience has kind of guided my search for a job. If anesthesia doesn't get a chance to meet a patient BEFORE going back to a room, that to me is kind of shady and FOS. I chose a university setting where the pace is certainly not private-practice fast, but at least I know my patient front to back before entering a room.

 

[Noyac]

Your friend can also negotiate with the hospital/surgeon/anesthesiologist. In her situation there is no way she can pay this bill in any prompt manner. Therefore, she can negotiate a lower bill and a payment schedule. Its done in many places. A friend of mine was uninsured when he cut off his finger in a press machine and he couldn't afford the bill. He called the surgeon and was able to negotiate a lower bill (50% Lower).

 

[Monty Python]

Hi everyone,

Recently, a classmate of mine had some abdominal surgery for which she received the bill for the surgery and her hospital stay last week which amounted to approx $31k after insurance.!

Last year my wife had a suspicious mammogram and could feel a lump. A general surgeon of my choosing recommended a breast biopsy after needle localization under flouro.

She was in xray for one hour, where a radiologist inserted the guide wires under flouro guidance using just SQ local.

She was then in the OR for less than 45 minutes for a general anesthetic with LMA. 30 minutes in PACU, one more hours in day surgery unit, and then home.

The bills:
Xray: $3,000
Radiologist (for guide wire insertion and reading several images that day): $1,250
Hospital lab: $500
Pathologist: $450
Surgeon: $1,100 (includes his first assistant fee)
Anesthesia group charge: $950
Hospital pharmacy: $845
OR charge: $3,375
PACU charge: $950
Hospital supply charges: $250
Hospital "anesthesia" fee: $650 which according to the business office was for use of the anesthesia machine and monitors. Does not include the Sevo fee - that came under pharmacy charge. The CRNAs at this hospital (where I work) are not hospital employees - we're group employees.

And this is for a healthy, ASA 1 outpt procedure which took 45 minutes, plus time in xray.

I do not believe my wife's care cost the hospital this much. What happens is "cost shifting" whereas the $$$$$$ bills from keeping grandma alive three more days in the ICU are spread around to all patients to share in the financial pain.

It's also part of the lovely legal system in our country. My wife's OBGYN pays $250,000/year just in malpractice premium.

As long as most Americans abuse their bodies, then present the hospital expecting a magic silver bullet for their care (cost be damned, and no matter how heroic or ultimately futile the effort they demand all possible interventions) the costs will continue to rise for all of us. Oh, never forget the added cost of everyone having a horde of plaintiff's attorneys looking over our shoulders.

 

[bulletproof]

Last year my wife had a suspicious mammogram and could feel a lump. A general surgeon of my choosing recommended a breast biopsy after needle localization under flouro.

She was in xray for one hour, where a radiologist inserted the guide wires under flouro guidance using just SQ local.

She was then in the OR for less than 45 minutes for a general anesthetic with LMA. 30 minutes in PACU, one more hours in day surgery unit, and then home.

The bills:
Xray: $3,000
Radiologist (for guide wire insertion and reading several images that day): $1,250
Hospital lab: $500
Pathologist: $450
Surgeon: $1,100 (includes his first assistant fee)
Anesthesia group charge: $950
Hospital pharmacy: $845
OR charge: $3,375
PACU charge: $950
Hospital supply charges: $250
Hospital "anesthesia" fee: $650 which according to the business office was for use of the anesthesia machine and monitors. Does not include the Sevo fee - that came under pharmacy charge. The CRNAs at this hospital (where I work) are not hospital employees - we're group employees.

And this is for a healthy, ASA 1 outpt procedure which took 45 minutes, plus time in xray.

I do not believe my wife's care cost the hospital this much. What happens is "cost shifting" whereas the $$$$$$ bills from keeping grandma alive three more days in the ICU are spread around to all patients to share in the financial pain.

It's also part of the lovely legal system in our country. My wife's OBGYN pays $250,000/year just in malpractice premium.

As long as most Americans abuse their bodies, then present the hospital expecting a magic silver bullet for their care (cost be damned, and no matter how heroic or ultimately futile the effort they demand all possible interventions) the costs will continue to rise for all of us. Oh, never forget the added cost of everyone having a horde of plaintiff's attorneys looking over our shoulders.

😱 😱 😱 all that for a 45-minute procedure. I'm moving to canada.

 

[Beck928]

Last year my wife had a suspicious mammogram and could feel a lump. A general surgeon of my choosing recommended a breast biopsy after needle localization under flouro.

She was in xray for one hour, where a radiologist inserted the guide wires under flouro guidance using just SQ local.

She was then in the OR for less than 45 minutes for a general anesthetic with LMA. 30 minutes in PACU, one more hours in day surgery unit, and then home.

The bills:
Xray: $3,000
Radiologist (for guide wire insertion and reading several images that day): $1,250
Hospital lab: $500
Pathologist: $450
Surgeon: $1,100 (includes his first assistant fee)
Anesthesia group charge: $950
Hospital pharmacy: $845
OR charge: $3,375
PACU charge: $950
Hospital supply charges: $250
Hospital "anesthesia" fee: $650 which according to the business office was for use of the anesthesia machine and monitors. Does not include the Sevo fee - that came under pharmacy charge. The CRNAs at this hospital (where I work) are not hospital employees - we're group employees.

And this is for a healthy, ASA 1 outpt procedure which took 45 minutes, plus time in xray.

I do not believe my wife's care cost the hospital this much. What happens is "cost shifting" whereas the $$$$$$ bills from keeping grandma alive three more days in the ICU are spread around to all patients to share in the financial pain.

It's also part of the lovely legal system in our country. My wife's OBGYN pays $250,000/year just in malpractice premium.

As long as most Americans abuse their bodies, then present the hospital expecting a magic silver bullet for their care (cost be damned, and no matter how heroic or ultimately futile the effort they demand all possible interventions) the costs will continue to rise for all of us. Oh, never forget the added cost of everyone having a horde of plaintiff's attorneys looking over our shoulders.

Damn! Makes me rethink the idea of a knee scope which will someday need to be done...

 

[rs2006]

Hi all,
I hope all is well for everyone here and thanks for the responses above. The statements above are interesting, but I find it strange that no one has addressed my real question-- in light of the fact that the bill is so high and that realistically no mere mortal can afford bills so high, how does the bill (such as the one abvove) really get paid-- lets say for example, that of the bill above, the average american saves and is able to pay maybe approx 2k of the original bill-- what happens to the amount that is lost?-- based on the posts of this forum it seems as if we, as physicians (I am a medical student, doc to be), seem to feel that we will ALWAYS get paid all the $$ and that, someone else is going to pick up the tab for the rest of the bill-- what gives??

Damn! Makes me rethink the idea of a knee scope which will someday need to be done...

 

[Annette]

😱 😱 😱 all that for a 45-minute procedure. I'm moving to canada.

And wait in line for don't know how many weeks/ months to get into see a radiologist/surgeon/surgery/etc.

To answer the op, insurance pays, and sometimes the patient pays part of the remainder or takes the hit on the credit report/bankruptcy. Then the costs get shifted again to another patient/ cost center.

In a bid to "control costs" my hospital has given each nursing unit a budget for supplies, etc, which get reimbursed when the patient is billed (the yellow and orange stickers). The budgets are getting so tight that the unit clerks will give you an index card if they like you, and now you have to scrounge for your own blood culture bottles! Forget having hespan on the floor for emergencies! I've had to have the stat carts cracked a couple of times just to get IV fluids as the nursing directors have directed that the floor will not stock any extra IV fluids.

Great American medical system, ain't it?